1992, 08-20 Permit App: 92006663 Mechanical FixturesMECHANICAL PERMIT APPLICATION FORM - CD- (0L00'3
, Information Worksheet
JOB STREET ADDRESS: d) D 9 i&-ci.Q-e
CITY/STATE/ZIP: ~r"` . Lo% PARCEL NUMBER: -
OWNER: %zA..4 ,. a Y .eata.e PHONE NUMBER: l.'l.2 - 3a 9 7
MAILING ADDRESS: • 4-,. L
/ , (Street) (City/State) - (ZIp)
G
CONTRACTOR: -) y 11)1 d" LICENSE NUMBER: W YATJ-H C-) o/ cH
t/ PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS,EQUIPMENTii100,000'BTU..(INCLUDES
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS PIPING(EA OUTLE
BOILER/REFRIG 1-100M BTU
BOILER/REERIG.101 500M,BTU r ...
i:S":r:i';.;:;ir"...r'
BOILER/REFRIG 501-1,000M BTU
:BOILER/REFRIG. 1,0001.h1,750M•BTU ';
BOILER/REFRIG+1,750M BTU
HEAT'PUMP & AIF.; CONDITIONER
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT, PUMP? &,AI(a CONDITIONER`15-30 TONS..;....:.:':
HEAT PUMP & AIR CONDITIONER 30-50 TONS
`HEAT PUMP '&'AIR'.+OND,ITION♦;+5tl,,TON5
VENTILATING FANS
EVAPORATIVE COOLEFIS .'.`: :':: .I:.'.:.'.
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
:TYPE
CLOTHES DRYER
::;>;...
_?;>: fi c..:.; >; :: `'.;a'... "(: ;::i., >. z;,• ;.;.:;;:,>.:>:>. ^ <.:•rr.::` ::`.:.:.:.
GAS LOG
:MISCELLANEOUS. Not COVERED •ELSEWHERE':::..
UNLISTED GAS APPLIANCE <400,000 BTU
sULINSTED,GAS
USED APPLIANCE <400,000 BTU
USEDAPPLIANCE>400,000:BTU,;'<.:
AIR HANDLER <10,000 CFM
-
AIR,HANDi.:,ER >10;000 CFMa
NOTE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x12.00 =
x 15.00 =
/
10,00
/
ia.p0
a
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
9_,,es0
SUBTOTAL
$ ani
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$ Ick
SIGNATURE !/C L -AD.'�-lam,
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675